Physician Advisor Medical Director

4 weeks ago

Palo Alto, California, United States Stanford Health Care Full time

If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered.

Day - 08 Hour (United States of America)This is a Stanford Health Care job.

A Brief Overview
The Physician Advisor Medical Director is a key member of the leadership team for ensuring the effective, efficient utilization of health care services. In addition, this person will provide expertise related to physician practice patterns, care variation reduction, care coordination management, level of care progression, denial management, length of stay, patient flow, clinical documentation improvement, and governmental regulations compliance.

Locations
Stanford Health Care

What you will do
  • Maintains knowledge of regulatory and accreditation requirements related to utilization review, level of care, and clinical documentation.
  • Works with Compliance to interpret new regulatory and compliance requirements and develops standard system-wide implementation plans and policies.
  • Works with system Case Management executive leadership and other Physician Advisors to understand and standardize the implementation of Case Management processes and policies.
  • Provides clinical expertise to case management regarding admission status determinations, delays in discharge, denial management, and secure authorizations from commercial payors.
  • Promotes high-value care, efficient utilization of resources, effective patient flow, and appropriate length of stay management.
  • Ensures patients are in the appropriate level of care with supporting documentation of regulatory compliance and accurate coding.
  • Acts as a consultant to and resource for attending physicians regarding their decisions relative to the appropriateness of hospitalization, continued stay, and use of resources.
  • Acts as the Clinical Documentation Improvement professional to facilitate accurate and complete documentation for coding and abstracting of clinical data, capture of severity, acuity, and risk for mortality, in addition to DRG assignment.
  • Maintains current knowledge of federal, state, and payer regulatory and contract requirements.
  • Ensures Joint Commission and other accrediting body requirements specific to care coordination are fulfilled, but also understand the linkage between the care coordination department's requirements and those of the integrated delivery system.
  • Participates in the Utilization Management Committee (CERM), LOS MGT Committee, Long LOS weekly huddle, bed capacity, and other committees as applicable.
  • Develops strong relationships with Med Staff, Case Management, nursing staff, Clinical Documentation program, UBMD program, and Executive leadership to enhance alignment on key strategic goals.
  • Develops productive and sustainable partnerships and relationships with leaders of post-acute facilities that include SNFs, Subacute facilities, and LTACHs.
  • Identify opportunities for process improvements as they relate to LOS, cost per case, and/or other care management related goals.
  • Provides structured feedback via annual performance evaluation for other Physician Advisors.
  • Serves as a resource for Physician Advisors to obtain guidance and assistance.
  • Provides coaching to Physician Advisors as well as assists with recruiting and onboarding new Physician Advisors.
  • Maintains license, certification, and continuing education as required.
  • Performs other duties and attends committees as requested.
Education Qualifications
  • Completion of specialty residency (e.g., Internal Medicine, Emergency Medicine).
  • Master of Science degree in a work-related discipline/field from an accredited college or university preferred
Experience Qualifications
  • Five (5) years of progressively responsible and directly related work experience; previous experience as a physician advisor required.
  • Two (2) years of administrative background as a physician manager required.
  • Experience leading large-scale change efforts and/or academic medicine preferred.
  • Any combination of education and experience that would likely provide the required knowledge, skills, and abilities as well as possession of any required licenses or certifications is qualifying.
Required Knowledge, Skills and Abilities
  • Ability to communicate effectively at all organizational levels and in situations requiring instructing, persuading, negotiating, conflict resolution, consulting, and advising, as well as flawless written communication.
  • Ability to establish and maintain effective relationships with widely diverse groups, including individuals at all levels both within and outside the organization and gain their cooperation.
  • Ability to plan, organize, motivate, mentor, direct, and evaluate the work of others.
  • Ability to resolve conflicts and/or negotiate with others to achieve positive results; establish and maintain effective interpersonal relationships.
  • Ability to build clinical credibility among physician peers.
  • Ability to teach, coach as well as provide leadership, and influence others.
  • Ability to work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families.
  • Knowledge of Post-acute levels of care such as Home Health, Hospice, AIM, Palliative Care, SNF, LTAC, B&C, Sub-acute, Acute rehab.
  • Knowledge of coding and DRG assignment process preferred.
  • Knowledge of admission criteria for all levels of care and denials management.
  • Knowledge of case management principles, processes, and their practical application preferred.
  • Knowledge of Centers for Medicare and Medicaid Services rules and regulations, and interest in building this knowledge through experience and partnership with Case Management.
  • Knowledge of clinical documentation requirements.
  • Knowledge of clinical, quality, and administrative facets of the healthcare industry.
  • Knowledge of principles of process improvement methodology, business and management strategic planning, leadership development, and education techniques.
Licenses and Certifications
  • MD - CA Physician or
  • DO -Osteopathic Physician (Do) - State Licensure
Physical Demands and Work Conditions
Blood Borne Pathogens
  • Category II - Tasks that involve NO exposure to blood, body fluids or tissues, but employment may require performing unplanned Category I tasks
These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford's patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family's perspective:
  • Know Me: Anticipate my needs and status to deliver effective care
  • Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
  • Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $ $128.53 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

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